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Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Using analytics tools to improve cancer treatment can be very hard. That struggle is exemplified by the problems faced by IBM Watson Health, which dove into the oncology analytics field a few years ago but made virtually no progress in improving cancer treatment.

With any luck, however, Via Oncology will be more successful at moving the needle in cancer care. The company, which offers decision support for cancer treatment and best practices in cancer care management, was just acquired by information analytics firm Elsevier, which plans to leverage the company’s technology to support its healthcare business.

Elsevier’s Clinical Solutions group works to improve patient outcomes, reduce clinical errors and optimize cost and reimbursements for providers. Via Oncology, a former subsidiary of the University of Pittsburgh Medical Center, develops and implements clinical pathways for cancer care. Via Oncology spent more than 15 years as part of UPMC prior to the acquisition.

Via Oncology’s Via Pathways tool relies on evidence-based content to create clinical algorithms covering 95% of cancer types treated in the US. The content was developed by oncologists. In addition to serving as a basis for algorithm development, Via Oncology also shares the content with physicians and their staff through its Via Portal, a decision support tool which integrates with provider EMRs.

According to Elsevier, Via Pathways addresses more than 2,000 unique patient presentations which can be addressed by clinical algorithms and recommendations for all major aspects of cancer care. The system can also offer nurse triage and symptom tracking, cost information analytics, quality reporting and medical home tools for cancer centers.

According to the prepared statement issued by Elsevier, UPMC will continue to be a Via Oncology customer, which makes it clear that the healthcare giant wasn’t dumping its subsidiary or selling it for a fire sale price.

That’s probably because in addition to UPMC, more than 1,500 oncology providers and community, hospital and academic settings hold Via Pathways licenses. What makes this model particularly neat is that these cancer centers are working collaboratively to improve the product as they use it. Too few specialty treatment professionals work together this effectively, so it’s good to see Via Oncology leveraging user knowledge this way.

While most of this seems clear, I was left with the question of what role, if any, genomics plays in Via Oncology’s strategy. While it may be working with such technologies behind the scenes, the company didn’t mention any such initiatives in its publicly-available information.

This approach seems to fly in the face of existing trends and in particular, physician expectations. For example, a recent survey of oncologists by medical publication Medscape found that 71% of respondents felt genomic testing was either very important or extremely important to their field.

However, Via Oncology may have something up its sleeve and is waiting for it to be mature before it dives into the genomics pool. We’ll just have to see what it does as part of Elsevier.

Are there other areas beyond cancer where a similar approach could be taken?

Personalized/precision medicine is a growing field and that trend shows no sign of slowing down.

In fact, a 2016 Grand View Research report estimated the global personalized medicine market was worth $1,007.88 billion in 2014, with projected growth to reach $2,452.50 billion by 2022.

As these areas of medicine become more commonplace, understanding the interactions between biological factors with a range of personal, environmental and social impacts on health is a vital step towards achieving sustainable success.

A better understanding begins with answering important questions such as whether the focus should be precision population medicine (based on disease) or precision patient-specific medicine (based on the individual).

Specificity in terminology is needed. The traditional term of “personalized medicine” has evolved into the term “precision medicine,” but this new usage requires a more detailed look into the precise science of genetic, environmental and lifestyle factors that influence any approach to treatment.

Comprehending the interactions between biological factors with a range of personal, environmental, and social impacts on health can provide insights into success and we’ve learned that some areas of precision medicine are more effective than others.

Through pharmacogenomics – the study of understanding how a patient’s genetic make-up affects the response to a particular drug – we have identified key enzymes in cancer formation and cancer treatment, which aids in the customization of drugs.

Research shows us that drug-metabolizing enzyme activity is one of many factors that impact a patient’s response to medication. We also know that human cytochrome P450 (CYP) plays an important role in the metabolism of drugs and environmental chemicals.

Therapies that incorporate drug-specific pharmacogenomics are a boon to oncology treatments and a vast improvement over the “shotgun therapy” approach of the past. Today, treatments can be targeted to enzymes and receptors that vary from person to person.

In traditional chemotherapy, a drug developed to kill rapidly growing cancer cells will indiscriminately target other rapidly growing cells such as hair cells, hence the often-observed hair loss. However, a targeted drug and delivery method aimed at only the receptive cells can be a much more effective approach and treatment, while minimizing collateral damage.

Recently, the journal Nature published a study showing the promise this method holds. In the pilot study, scientists led by Dr. Catherine Wu of Dana-Farber Cancer Institute in Boston gave six melanoma patients an experimental, custom-made vaccine and, two years later, all were tumor-free following treatment.

Looking Beyond Genetics

Precision medicine needs to include more than just genetics.

Factors such as environment and socio-economic status also must be included when approaching disease states and we must undertake a comprehensive overview of a patient’s situation, including, but not limited to, family history.

Cultural dietary traditions can play into disease susceptibility. As an example, the frequent consumption of smoked fish in some Asian cultures increases their risk of gastric (stomach) cancers. Lower socioeconomic status can force acceptance of substandard and overcrowded housing with increased risk of illness ranging from lead toxicity, asbestosis, and Hantavirus to name a just a few.

A patient with a genetic propensity for lung cancer who also smokes cigarettes and has high radon levels in their home is increasing the odds of developing disease due to these combined genetic, behavioral, and environmental factors.

Patient-derived Data and the Diagnosis

In addition to the information now available through state-of-the-art medical testing, patient-derived information from wearables, biometrics, and direct-to-consumer health testing kits, presents patients and physicians alike with new opportunities and challenges.

Armed with newly discovered health data, patients may present it to their doctors with a request that it be included in their health record. Many patients expect an interpretation of that data when they visit their doctor and an explanation of what it means for their present (and future) healthcare.

Doctors can be overwhelmed when unfiltered information is thrown at them. Doctors are not prepared and research has yet to offer definitive support for interpretation of patient-derived data.

Studying hereditary traits can offer some insights from generation to generation. By delving into genomics of individual patients, we get a clearer picture into a person’s risk factor for a certain disease, but often this information provides no immediate solutions. Discovering a genetic indicator for Alzheimer’s, may reflect a higher propensity for the disease, but symptoms may be decades away, if they appear at all.

Pitfalls and Possibilities

There are many concerns about genomic data collection, one of which is whether policies can keep pace with patient privacy and the related ethical questions that inevitably ensue. These questions are consistently surfacing and there is no clear direction on the best course of action.

Clearer policies are needed to delineate who has access to a patient’s genetic records and whether third parties, such as health or life insurance companies, can deny coverage or care based on genomics.

In addition, one cannot ignore the psychological burden associated with knowing your “potential” for a disease, based solely on your genetic testing, when it may never come to fruition. Not to mention, its effect on planning for one’s future decisions relative to career, residence, and relationship commitments.

Even some physicians are reticent to undergo genetic testing for fear of who might gain access to the information and the consequences thereof.

Physicians face an additional conundrum in dealing with patient-supplied information: How to counsel patients when, in some cases, the task should be the responsibility of a community resources representative? In addition, patients who request that certain information not be included in their personal health record, present a problem for a physician justifying a test or a procedure to a payer.

The consumerization of healthcare and patient engagement strategies employed to deliver better outcomes are driving the healthcare industry to open conversations that elevate the level of care delivered to patients. In addition, physicians need to demand more direction and initiate more discussions on how to deal with the opportunities and challenges presented in the era of patient-derived and pharmacogenomics data.

While improving patient-physician communication should always be a priority, discussing how and when to use genetic and patient-derived information is still a work in progress.

The following is a guest blog post by Peter Edelstein, MD, is the Chief Medical Officer at Elsevier.
Today’s healthcare reform world is filled with buzzwords. “Population Health Management.” “Value-Based Care.” “Patient Engagement.” I am in no way suggesting that these topics do not play critical roles if we are to realize the enormous potential of healthcare reform. However, if you ask ten people to define any one of these buzzwords, you’ll receive twelve different definitions. And in a world of threatening reimbursement penalties and expanding healthcare legislation, the sooner that we come to some consensus on the basic meaning of these terms, the sooner we can understand the associated myths and realities.

Relative to the patient population (that is, the general population), the population of providers (doctors, nurses, and other clinicians) represents a fairly homogeneous and small group to target with initial reform efforts. In addition, we are all painfully aware of the unacceptable number of preventable deaths and complications which occur at the hands of providers each and every day. Thus reform legislation has first focused on reducing variability, elevating quality, and controlling the cost of care delivery through programs focused on providers (hospitals and healthcare systems, as well as the physicians, nurses, other clinicians who work in such institutions).

Again, this makes sense as a starting point. That said, to believe that we will achieve our ultimate goals of evolving into a system dominated by preventative care and outpatient and home health maintenance (leaving hospitals to serve only those whose chronic conditions can no longer be controlled in the outpatient setting) solely by changing how providers deliver care is a myth of epic proportions. Far-and-away our greatest opportunity to shift our population’s health from reactive, acute, and expensive to proactive, preventative, and cost-efficient is by directly engaging and educating and empowering the general population of patients and future patients themselves.

This perspective is based on two major realities. First, studies (as well as our own experience) confirms that even individuals with chronic conditions spend on average only a handful of hours annually in front of a professional care provider. (How many hours did you or your spouse spend under the direct care of a provider in the previous twelve months? For the overwhelming majority of you, the answer is less than a couple.) Second, patients who demonstrate interest in and ownership of their health have better clinical outcomes and reduced costs of care. In a nutshell, people spend virtually all of their lives away from doctors, nurses, and hospitals, and as with virtually any complex processes, those who are more involved and knowledgeable have better outcomes.

Now we come up against another reality: limited resources. Hospitals and healthcare systems have limited staff and finances, and Patient Engagement often draws the short straw when competing with electronic health records, computerized order sets, and other provider-specific support solutions. But, as I’ve suggested, de-prioritizing Patient Engagement as “less important” or “less impactful” is a myth which greatly limits our potential to increase the value (elevate quality/reduce costs) of healthcare delivery. Thus, the most important first step for healthcare stakeholders to accept is the reality that assigning resources to Patient Engagement must be as great a priority (if not greater) as allocating staff and money to products and solutions which target only traditional providers.

Once healthcare leaders accept the critical importance of Patient Engagement, they again have to consider their limited resources. It is another common and perilous myth when trying to allocate resources and develop and implement Patient Engagement strategies to consider all patients within a healthcare system’s catchment area as a homogeneous population. The reality here is that not all individuals have the same potential for or barriers to becoming engaged patients. And understanding with which patient subpopulations you can get “the most bang for your buck” is a necessity which is often overlooked.

For example, any of us who have directly cared for a large cohort of patients knows that there are some individuals (comprising a patient subpopulation) who simply have no intention of ever lifting a finger to care for themselves. I think about the roughly 50% of Americans with chronic conditions who fail to take their medications as prescribed. Or the diabetics who simply cannot be troubled with checking their blood sugars. Every provider can immediately call to mind dozens of patients who, understanding how to better their own health, simply refuse to do so. The reality is that as in all areas of life, there are simply some people who just will not engage, be accountable, take ownership. To waste valuable resources trying to engage this patient subpopulation is foolish, disillusioning for staff, and wasteful, and it is best to quickly identify these individuals and accept that all you can do is provide reactive care when they become ill.

A second and large patient subpopulation is well worth the resources and efforts to engage. These are the folks with limited literacy and numeracy skills. Multiple studies have demonstrated the inverse relationship between literacy and healthcare outcomes. Thus, assigning resources to clearly engage and educate these individuals so that they have the knowledge and understanding necessary to engage is worthwhile.

The third large patient subpopulation worth targeting is comprised of people whose upbringing or culture serves as a barrier to engagement. Perhaps the largest of these cohorts is elderly Americans, many of whom were raised never to question a physician or ask for clarification. Such patients are unable to engage because they refuse to address their lack of understanding of recommendations for their self care. Another large faction are those who were raised in cultures (often outside of the United States) where, as with elderly Americans, the provider is God, never to be questioned. Thus, these folks don’t really understand what they can do to improve their health, and they refuse to ask for further clarification.

The reality for these two large patient subpopulations is that the appropriate use of resources to understand and directly address the obstacles to true engagement and education can result in great successes.

In the end, our ability to achieve truly dramatic and impactful healthcare reform depends to a great extent on engaging and educating the patients of today and tomorrow. Appreciating this reality, and understanding the realities related to identifying patient subpopulations which can truly be engaged and educated is the best approach to achieving successful reform.

About Peter Edelstein, MD
Peter Edelstein, MD, is the Chief Medical Officer at Elsevier. Edelstein is board certified by the American College of Surgeons and the American Society of Colon and Rectal Surgery. He has more than 35 years of experience practicing medicine and in healthcare administration. Edelstein was in private practice for several years before serving on the surgical faculty at Stanford University, where he focused on gastrointestinal, oncologic and trauma surgery. He then spent more than a decade as an executive in the Silicon Valley medical device industry. Edelstein’s most recent role was as Chief Medical Officer for the healthcare business at LexisNexis Risk Solutions, a Reed Elsevier company. He is also the author of the recently published book, ‘Own Your Cancer: A Take-Charge Guide for the Recently Diagnosed & Those Who Love Them’.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Note: The following image will become the live video stream about 5 minutes before the start of the G+ hangout and then will be the embedded video after the hangout. Subscribe Here to be notified of future hangouts.

Jonathan Teich, MD, PhD, Elsevier’s Chief Medical Informatics Officer and a physician at Brigham and Women’s Hospital in BostonWhat: A Google+ Video Hangout with Jonathan Teich, MD discussing where we’re at with clinical decision support and where the technology is heading. We’ll also discuss how clinical decision support can improve clinical care, prevent adverse events, and streamline clinical workflow.Date: Thursday, February 13, 2014Time: 12:00 – 12:30 p.m. ESTLocation: About 5 minutes before the event, we’ll embed the video stream on this page or you can find the video stream on the G+ hangout event page as well.

About Jonathan Teich
Jonathan’s primary focus lies in the design of innovative information systems to directly improve clinical care, prevent adverse events and streamline clinical workflow to address the most critical needs of the healthcare community.

A practicing physician, Jonathan boasts a wealth of experience in the scientific and technical fields. He is an assistant professor of medicine at Harvard, and a board-certified attending physician in emergency medicine at Brigham and Women’s Hospital (BWH), where he has practiced since 1983.

A recognised leader in his field, Jonathan serves on a number of industry and government leadership councils. He is co-chair of the panel responsible for the HHS-sponsored Roadmap for National Action on Clinical Decision Support and is a board member of the eHealth Initiative, a fellow of the American College of Medical Informatics and of HIMSS, and a member of the American Health Information Community Quality Workgroup. He has authored or co-authored over 100 peer-reviewed papers, books, and editorials in the field of medical informatics and healthcare information systems.

Jonathan has also helped to found Healthvision, Inc., an internet healthcare company producing innovative, web-based, clinical information systems and patient/community information sites for large healthcare organisations. He served Healthvision as chief medical officer, responsible for strategic product vision across clinical and patient product areas.

Subscribe Here to be notified of future EHR and Healthcare IT hangouts.

If you have any questions you’d like to pose before or during the hangout, send them to @ehrandhit on Twitter and we’ll do our best to incorporate them into the discussion.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I use to do this a lot more when I started blogging, but I’m so busy with all the Healthcare Scene blogs that I don’t do it nearly as much. Although, I think it’s interesting to take a quick look at some of the stats for EMR and HIPAA and also take a minute to recognize the new and renewing advertisers on the site. I hope you’ll indulge me for a minute and you’ll take a look at those companies that support the work I do here on EMR and HIPAA. Most of them are not only sponsors of the site, but also readers. That means a lot to me.

First, let’s take a look at some stats for EMR and HIPAA. This will be the 1,318th post and there have been 6417 comments on those posts. That’s about 5 comments a post which is pretty incredible. According to WP.com stats, we’ve had 5,920,478 pageviews since I started using that stats program in July 2007. Since my first blog post was back in December 2005, that puts us well over 6 million pageviews.

This is astounding to me. I remember when I thought that maybe 1000 pageviews a day was the entire EHR market online. I’m glad I was wrong. Thanks for everyone that’s been reading. In fact, in another milestone, the EMR and HIPAA email subscription just blew by 4000 subscribers (now at 4,079). Considering I mistakenly didn’t start this email list until 2009, I’m happy that 4000 people want a daily email from EMR and HIPAA. Add in the 15,538 twitter followers on @ehrandhit and I’m humbled beyond belief.

Speaking of humbling experiences, this list of new and renewing EMR and HIPAA sponsors is really humbling as well. I’m very appreciative of their support.

New EMR and HIPAA AdvertisersGreenway – I’d been talking with Greenway for about a year about advertising on my network of websites. They might have been a little busy with something called an IPO (GWAY) that slowed the discussion. Now that the IPO is out of the way, we were able to finally finish up the details of Greenway advertising. For those who don’t know Greenway, they provide an integrated EHR and clinical research solution to more than 40,0000 providers in 30 specialties. Greenway has a single-database EHR, PM and interoperability solution called PrimeSUITE®. As one Greenway partner said to me at HIMSS, “Greenway is a good company with good people trying to do good for healthcare.” I can’t say I’ve seen anything to say otherwise.

NoMoreClipboard – The President of NoMoreClipboard, Jeff Donnell, was my first ever meeting at HIMSS. NoMoreClipboard has been doing some really interesting things since then including it’s most recent partnership with iMPak (see my interview with NoMoreClipboard and iMPak). I’d label iMPak as the most creative technology that I found at HIMSS 2012. Once I get a good demo video of the product, I’ll be doing a full post about it. It makes a lot of sense for the iMPak technology to be put together with the NoMoreClipboard technology. I’m looking forward to see what else they do together as well.

Online Tech – I think this is the first time I’ve had a web hosting company advertise on my site. After talking with Online Tech, I think I know why they want to advertise on EMR and HIPAA. Most hosting companies pay lip service to HIPAA, but Online Tech takes it very seriously. While I haven’t done a really deep dive into all the details of their hosting and HIPAA compliance, I could quickly tell how much HIPAA privacy and security was part of their culture. I believe HIPAA compliance is less about perfection and more about intent and effort. I think those who work with Online Tech won’t have to worry as much about being a “Covered Entity with Egg on Their Face.”

Renewing EMR and HIPAA Advertisers
Now to those companies that have renewed their ads on EMR and HIPAA since my last update:Sequelmed (Advertising Since November 2009)Ambir (Advertising Since January 2010)Mitochon (Advertising Since December 2010)Amazing Charts (Advertising Since May 2011)Elsevier (Advertising Since September 2011)

As you can see, a number of them have been supporting EMR and HIPAA for a lot of years. I look forward to many more years working together with them.

No doubt this list and the numbers above set a high bar for me which I don’t take lightly. I’m sure I often don’t measure up, but I’ll keep doing what I can to provide value to people. Thanks for reading.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, the way I’m able to run EMR and HIPAA and the rest of the Healthcare Scene blog network is thanks to the great EMR & Health IT advertisers that support the work we do. Luckily, we and our advertisers have done really well. In fact, I just noticed last night that a couple weeks ago EMR and HIPAA itself just passed 5 million pageviews (5,062,416 if you’re keeping count). Thankfully readership continues to increase across the whole network.

One challenge that some advertisers have with my current advertising is that it’s a flat rate for the month. In order to solve this problem, I’m launching a new advertising option that’s done on a CPC (cost per click) basis. This is the same model that Google Adwords uses, but you’ll be able to do it on a set of very targeted EMR, EHR and healthcare IT websites. I’m doing my initial tests for this on EMR Thoughts & EMR and EHR videos. If you’re interested in trying out this performance based advertising, drop me a line on our contact us page and I’ll send you more details.

If you like this type of performance based advertising and you have an important EMR or healthcare IT message to get out, wait until you see what I have brewing at Influential Networks.

Enough about the exciting changes to the EMR and HIPAA advertising. Now a look at the new Advertisers on EMR and HIPAA.EHR Selector – As some of you might remember, I wasn’t a big fan of EHR Selector in the past, because I didn’t think many doctors would want to pay what they were charging to use their service. However, EHR selector came to me wanting to advertise their special 6 month free offering to use their EHR selection service and that was something I could get on board and support. EHR Selector has some of the most granular EHR company filtering that’s out there. They’ve added nice filters like the EHR Certification status of each EHR software. Sign up (It’s free after all) if you’re looking at selecting an EHR or helping others select an EHR.

Elsevier – This is a very large company with a wide variety of healthcare products. I’ll just focus on the one that they’re advertising on EMR and HIPAA: Gold Standard Drug Database. I believe most parts of an EMR should be built in house, but the one part of an EMR that is definitely better to get from a third party provider is the drug database. Gold Standard Drug Database is one option that EMR and EHR vendors should consider. It combines current, accurate content along with intelligent decision support for your drug database. The best part is that as an EHR company you don’t have to keep it up to date since Elsevier is already doing that for you and pushing you the updates.

Cerner – Many of you might remember my previous interviews with Cerner meaningful use physician #23 and Jan Patterson. Cerner has been a major player in the EHR industry for quite a while despite many people not really knowing much about them. A simple example of how large they are is that Cerner Ambulatory clients have secured more than $3.3 million in Meaningful Use incentives. Divide that by the $18,000 per provider and that’s a lot of providers using Cerner ambulatory EHR.

Also, as always, I don’t want to forget to thank those advertisers that have renewed their EMR and HIPAA ad. Since the last time I posted, SOAPware, Mitochon, HIT Forum, and Sequelmed have all renewed their ad. Thanks for supporting us. If you enjoy the content I create, then please take a second to check out these advertisers.

Now on to the next 5 million pageviews on EMR and HIPAA. A big thanks to all those that read our work.

I am starting to think that app development contests are a dime a dozen right now, but to me that just shows how many companies are interested in developing apps of all kinds. This contest may be one of the most broad ideas that I have seen.

Elsevier, the world-leading publisher of scientific, technical and medical information, is sponsoring a contest “to help more than 15 million researchers, medical professionals, librarians and students navigate scientific content, improve scientific search and discovery, visualize sophisticated data in more insightful and attractive ways and stimulate collaboration.”

This is no small task considering the amount of information that Elsevier provides. According to the contest website their content and meta data contains more than 10 million full text articles.

The contest offers even more than just cash prizes. Developers will retain all of the IP rights to their submissions as well as having the opportunity to market their app to the aforementioned 15 million users from 10,000 different institutions on Elsevier’s SciVerse Application Marketplace.

I love how this contest opens up app development to a more educational side of the house. It is not just designed for the end users, but can be used by researchers and developers to further even more growth and development.

There is still a month left for submissions so if you are interested in finding out more about this contest or submitting an entry of your own you can do so on the contest website.

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